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Published on: April 19, 2017
Molecular characterization of fungi causing colonization and infection in organ transplant recipients: A one-year
Fereshteh Zarei1, Seyed Jamal Hashemi1,2, Mohammadreza Salehi3
1Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Background And Purpose:
Organ transplant recipients are vulnerable to fungal infections. The aim of this study was to determine the prevalence of fungal colonization and infections among patients who underwent various transplantations and molecularly characterize the etiological agents.
Materials And Methods:
This study was conducted on candidates for transplantation in Imam Khomeini Hospital, Tehran, Iran, from April 2017 to April 2018. All patients were monitored for fungal colonization or infections before and after transplantation. Isolated fungi were identified using molecular methods.
Results:
A total of 125 patients, including 86 males and 39 females, with the mean age of 52.2 years participated in the study (age range: 15-75 years). Out of 125 patients, 84 (67.2%) cases had fungal colonization that appeared pre- and post-transplantation in 21 and 63 cases, respectively (alone or concurrent with another infection in 55 and 29 cases, respectively). In addition, a total of 39 episodes of fungal infections were diagnosed in 36 (28.8%) recipients (alone or concurrent with colonization in 7 and 29 cases, respectively). Out of the 39 fungal infections, 9 cases appeared pre-transplantation, while the other 30 cases occurred post-transplantation. However, no fungal colonization or infection was observed in 34 (27.2%) patients. Oral candidiasis (n=20) was the most common type of infection, followed by funguria (n=7), onychomycosis (n=5), candidemia (n=3), rhinocerebral mucormycosis (n=1), cutaneous mucormycosis (n=1), cutaneous aspergillosis (n=1), and peritonitis (n=1). Six yeast species were recovered from colonization cases with the dominance of Candida albicans both before and after transplantation. The observed fungal infections were caused by 11 distinct species, including the members of Candida (i.e., C. albicans, C. glabrata, C. parapsilosis, C. tropicalis, and C. krusei), Aspergillus (i.e., A. oryzae and A. candidus), Rhizopus (i.e., R. oryzae and R. microsporus), Trichosporon asahii, and Trichophyton interdigitale. The results also indicated that the development of a fungal infection post-transplantation was associated with fungal colonization (r=0.0184; P=0.043).
Conclusion:
Based on the results, fungal colonization was a common finding in transplant recipients at Imam Khomeini Hospital. However, the incidence of fungal infections was comparable with those of other centers. As the oral cavity was the most common site of colonization and infection, it might be beneficial to take further care about the oral health of patients using effective mouthwash.
Insights
Fungal colonization is common in organ transplant recipients, affecting over 67% of patients. Oral candidiasis was the most frequent infection, highlighting the need for improved oral hygiene post-transplant.
Area of Science:
- Medical Mycology
- Transplant Infectious Diseases
Background:
- Organ transplant recipients face a high risk of fungal infections.
- Fungal colonization is a precursor to invasive fungal disease in immunocompromised individuals.
Purpose of the Study:
- To determine the prevalence of fungal colonization and infections in organ transplant recipients.
- To molecularly characterize the fungal agents responsible for colonization and infection.
- To investigate the association between pre-transplant colonization and post-transplant infection.
Main Methods:
- Prospective study of 125 transplant candidates at Imam Khomeini Hospital (April 2017-April 2018).
- Monitoring for fungal colonization and infections pre- and post-transplantation.
- Molecular identification of isolated fungal species.
Main Results:
- Fungal colonization occurred in 67.2% of patients, predominantly post-transplantation (63 cases).
- Fungal infections were diagnosed in 28.8% of recipients, with oral candidiasis being most common (20 cases).
- Candida albicans was the most prevalent species in colonization; 11 species caused infections, including Candida, Aspergillus, and Rhizopus.
Conclusions:
- Fungal colonization is highly prevalent in transplant recipients.
- The incidence of fungal infections is comparable to other centers.
- Enhanced oral care may reduce fungal colonization and infection rates, particularly oral candidiasis.
